The present invention relates to methods and apparatus for performing surgical procedures, particularly minimally invasive surgical procedures. More particularly, it involves percutaneous surgical procedures and instruments for accomplishing such procedures, wherein embodiments of the invention include percutaneous herniorrhaphy including mesh reinforcement and/or gall bladder procedures.
A hernia is an abnormal protrusion of an organ, tissue, or any anatomical structure through a forced opening in some part of the surrounding muscle wall. For example, if a part of the intestine were to protrude through the surrounding abdominal wall, it would create a herniaxe2x80x94an abdominal hernia. A hernia in the groin area, also called the inguinal region, is known as an inguinal hernia.
Before a piece of intestine, abdominal cavity tissue, or other bodily tissue, called a hernial mass, makes its way through a weak spot in the muscle wall, it must first push its way through the peritoneum, which is the membrane that lines the abdomen. The hernial mass, however, does not typically tear and protrude through the peritoneum. Thus, when the intestine or hernial mass protrudes, it usually takes the peritoneum with it and it is covered by the peritoneum. The peritoneal covering surrounding the piece of protruding hernial mass is called a hernial Sac.
One known method for hernia repair involves the use of a mesh material or patch to line and support the hernial defect. The integrity and longevity of an abdominal wall hernia repair has been increased by the use of a large segment of mesh whose perimeter extends beyond the visualized margins of the defect. In one procedure, the segment of mesh may be placed within the preperitoneal space, which is the area located between the muscle wall and the peritoneum.
The use of mesh to repair hernial defects was first described and used in open incision medical procedures. Improvements in medical procedures have also resulted in the use of mesh in laparoscopic procedures. The open incision method was typically used as a final solution after other methods had failed, because it required a major incision with lengthy hospitalization for recovery, it caused significant post-operative pain, and it required at least a six week convalescence to achieve adequate scarring and strength. The laparoscopic method has provided improvements because no muscle damaging incision is necessary, only small puncture wounds are used instead of incisions, it can be done on an outpatient basis, and less post-operative pain and convalescence generally results to the patient. Both procedures, however, are operative techniques that require general anesthesia and can require significant recovery time. Additionally, the direct cost of the laparoscopic procedure remains considerably high because of the equipment that is necessary for the procedure.
An apparatus and method is needed for improving abdominal wall herniorrhaphy. Furthermore, such an apparatus and method is needed to perform a percutaneous surgical procedure that can reduce the trauma associated with open incision and laparoscopic procedures.
One embodiment of the invention comprises accessing a percutaneous space using a tubular member, using the tubular member to place an introducer, and conducting tissue repair through the introducer. The tubular member may be positioned using anatomical landmarks, and the desired location of the tubular member may be assessed by means of contrast prior to placing a guide wire. After the guide wire is placed, the tubular member may be removed and replaced with a dilator and an introducer. The dilator is removed, and a form or a balloon is advanced into the preperitoneal space. The balloon""s shape may be varied to approximate the desired shape of the space near a defect to be repaired. The balloon may also function as a carrier of a mesh for repairing the defect, and it may be a residual or removable balloon. The method and devices of the invention may be used to repair hernial defects as well as other anatomical defects.
When the defect is repaired, i.e., the mesh, and/or a curable filling material, is deposited, the stem or guide wire of the tubular, member (e.g., catheter), any balloon remnant and the introducer may be removed. Closure of the single puncture and a simple dressing complete the procedure.
Apparatuses or instruments for the method of the present invention include a catheter-like delivery device and a balloon for delivery-thereby. More particularly, the apparatus may include a tubular member (e.g., catheter, needle trocar or the like), a guide wire, a dilator (if required), an introducer and a balloon. The balloon may be of any desired shape and size as long as it passes through the selected introducer.
Other features and advantages of the present invention will become more fully apparent and understood with reference to the following description and the accompanying drawings and claims.